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Scoring of Arousal 가천의대 신경과 박기형 EEG Arousal scoring rules 1.Subjects must be asleep, defined as 10 continuous seconds or more of the indications of any stage of sleep, before an EEG arousal can be scored (Figs. 1 and 2). Arousal scoring is independent of Rechtschaffen and kales epoch scoring (i.e. an arousal can be scored in an epoch of recording, which would be classified as wake by Rechtschaffen and Kales criteria). 2.A minimum of 10 continuous seconds of intervening sleep is necessary to score a second arousal (see Rationale section for discussion of 10 seconds as minimum sleep between arousals) (Figs. 3 and 4). 3.The EEG frequency shift must be 3 seconds or greater in duration to be scored as an arousal (see Rationale section for discussion of 3 seconds as the arousal duration of 3 seconds as the arousal duration criteria) (Figs. 1,5 and 6). 4.Arousals in NREM sleep may occur without concurrent increases in submental EMG amplitude ( Fig. 8 and 9) 5. Arousals are scored in REM sleep only when accompanied by concurrent increases in submental EMG amplitude alone. 6. Arousals cannot be scored based on changes in submental EMG amplitude alone. 7. Artifacts, K complexes or delta waves are not scored as arousals unless accompanied by an EEG frequency shift (as previously defined) un at least one derivation. If such activity precedes an EEG frequency shift, it is not included in reaching the 3-second duration criteria. When occurring within the EEG frequency shift, artifacts or delta wave activity are included in meeting duration criteria (see Rationale section for discussion of delta wave activity as an indicant of arousal) (Figs. 10-12). 8. The occurrence of pen blocking artifact should be considered an arousal only if an EEG arousal pattern is contiguous. The pen blocking event can be included in reaching duration criteria (Figs. 13-15). 9. Noncurrent, but contiguous, EEG and EMG changes, which were individually less than 3 seconds but together greater than 3 seconds in duration, are not scored as arousals (Fig. 16) 10. Intrusion of alpha activity of less than 3 seconds duration into NREM sleep at a rate greater than one burst per 10 seconds is not scored as an EEG arousal. Three seconds of alpha sleep is not scored as an arousal unless a 10-second episode of alpha free sleep precedes (Figs. 17 and 18). 11. Transitions from one stage of sleep to another are not sufficient of themselves to be scored as EEG arousals unless they meet the criteria indicated above. Cyclic Alternating Pattern(CAP) • a marker of arousal instability Identify 1. repetitive stereotyped EEG patterns 2. lasting <60 sec 3. separated by time-equivalent intervals of background activity • slow high voltage waves during phase A alternating with low voltage theta–delta activities during • phase B simultaneous modifications of cardiorespiratory rate, motor activity & CSF pressure Æ increased during phase A decreased during phase B An example of cyclic alternatin pattern in sleep stage 2 (phase A and the following phase B) Temporal range CAP sequence : 2–60s non-CAP : absence of CAP for .60 non-CAP CAP non-CAP The third phase A followed by non-CAP is not included in the CAP sequence The top couple is scored as a single phase A being the interval,2 s. The middle and bottom couples are scored as independent phase As Phase A • • • • • • • Delta bursts Vertex sharp transients K-complex sequences with or without spindles Polyphasic bursts K-alpha Intermittent alpha EEG arousals Phase A subtypes subtypes A1 • A phases with synchronized EEG patterns (If present, EEG desynchrony occupies ,20% of the entire phase A duration. Subtype A1 specimens include delta bursts, K-complex sequences, vertex sharp transients, polyphasic bursts with ,20% of EEG desynchrony. a decline from adolescence (71%) to young adulthood (61%), middle age (62%) and then a drop(47%) subtypes A2 • A phases with desynchronized EEG patterns preceded by or mixed with slow high-voltage waves – (a mixture of slow and fast rhythms with 20–50% of phase A occupied by EEG desynchrony. Subtype A2 specimens include polyphasic bursts with more than 20% but less than 50% of EEG desynchrony a moderate increase of muscle tone and/or cardiorespiratory rate. increase from adolescence (20%) to young adulthood (28%), remain quite stable throughout mature adulthood (27%) and then rise during senescence (35%). subtypes A3 • A phases with desynchronized EEG patterns alone (transient activation phases or arousals) or exceeding two thirds of the phase A length, – Predominantly rapid low-voltage rhythms with > 50% of phase A occupied by EEG desynchrony. Subtype A3 specimens include K-alpha, EEG arousals, and polyphasic bursts with .50% of EEG desynchrony. A movement artifact within a CAP sequence is also classified as subtype A3. enhancement of muscle tone and/or cardiorespiratory rate increase slightly from adolescence (9%) to young (11%) and mature (11%) adulthood, and then rise during senescence (18%). Thank You for Your Attention !!